Venkatnarayan Kavitha, Devaraj Uma, Krishnaswamy Uma Maheswari, Ramachandran Priya, Thomas Tinku, D'Souza George
Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India.
Department of Biostatistics, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India.
Lung India. 2020 Sep-Oct;37(5):384-388. doi: 10.4103/lungindia.lungindia_528_19.
Administration of local airway anesthesia is the principal determinant of procedural comfort during flexible bronchoscopy. However, the ideal method of administration is still unknown. In this study, we compared lignocaine administration using a spray catheter (SC) with "spray-as-you-go" technique.
Patients undergoing bronchoscopy were randomized to receive airway anesthesia with 2% lignocaine through the SC (SC group) or "spray-as-you-go" technique through the working channel (WC group). The primary outcome parameter was cough count, and the secondary outcome parameters compared were need for sedation, operator-rated procedural satisfaction and cough, and patient-rated comfort on a Visual Analog Scale (VAS).
One hundred and thirty patients were randomized with comparable baseline parameters. The median (interquartile range [IQR]) cough count was 28 (19, 37) in the WC group and 15 (9, 23) in the SC group (P < 0.001). Requirement for sedation was lower in the SC group (5 vs. 18; P = 0.003). The mean (standard deviation [SD]) VAS score for operator-rated satisfaction was 66.5 (16.8) in the WC group and 80.6 (14.2) in the SC group; P < 0.001. The median (IQR) VAS score for operator-rated cough was 35 (23, 44) in the WC group and 18 (11, 28) in the SC group; P < 0.001. However, there was no difference in the patient-rated comfort VAS (mean [SD] of 66.4 [14.5] in the WC group and 69.9 [13.0] in the SC group; P = 0.07).
Lignocaine instillation using the SC during bronchoscopy reduced cough, need for sedation, and improved operator satisfaction.
局部气道麻醉的实施是可弯曲支气管镜检查过程中操作舒适度的主要决定因素。然而，理想的给药方法仍不明确。在本研究中，我们比较了使用喷雾导管（SC）与“边走边喷”技术给予利多卡因的情况。
接受支气管镜检查的患者被随机分为两组，通过SC接受2%利多卡因气道麻醉（SC组）或通过工作通道采用“边走边喷”技术（WC组）。主要结局参数是咳嗽次数，比较的次要结局参数包括镇静需求、术者评定的操作满意度和咳嗽情况，以及患者在视觉模拟量表（VAS）上评定的舒适度。
130例患者被随机分组，基线参数具有可比性。WC组咳嗽次数的中位数（四分位数间距[IQR]）为28（19，37），SC组为15（9，23）（P<0.001）。SC组的镇静需求较低（5例对18例；P=0.003）。WC组术者评定满意度的平均（标准差[SD]）VAS评分为66.5（16.8），SC组为80.6（14.2）；P<0.001。WC组术者评定咳嗽的中位数（IQR）VAS评分为35（23，44），SC组为18（11，28）；P<0.001。然而，患者评定舒适度VAS无差异（WC组平均[SD]为66.4[14.5]，SC组为69.9[13.0]；P=0.07）。
支气管镜检查期间使用SC注入利多卡因可减少咳嗽、镇静需求，并提高术者满意度。
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